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Colorectal cancer screening follow-up registry — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeColorectal cancer screening follow-up registryUSMLE Step 3

A 29-year-old man has a painless solid intratesticular mass on ultrasound. AFP and beta-hCG are elevated, and CT shows no distant metastasis. What is the best next diagnostic and therapeutic step?

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Correct answer: B — Perform radical inguinal orchiectomy with high spermatic-cord ligation

The best answer is “Perform radical inguinal orchiectomy with high spermatic-cord ligation”. A suspicious testicular mass is diagnosed and treated through an inguinal orchiectomy. Transscrotal biopsy disrupts lymphatic drainage and risks tumor seeding. A suspicious intratesticular mass is managed with radical inguinal orchiectomy rather than transscrotal biopsy.

Reference: AUA Testicular Cancer Guideline: https://www.auanet.org/guidelines-and-quality/guidelines/testicular-cancer-guideline